Treating the Symptoms of Essential Tremor with Focused Ultrasound: Melissa’s Story

Three decades ago, Melissa Kurtz, now 71, began experiencing stiffness in her left hand. At times, she would grip a pen so hard that the hand froze.

As a left-handed person working in graphic design and advertising, it was an annoying problem. It was also worrisome, as she feared she had Parkinson’s disease.

A local neurologist found Melissa in fact had essential tremor. This common movement disorder causes uncontrollable shaking—usually first noticed in the dominant hand. Eventually, it can also affect the other hand, legs, head, and voice. Essential tremor most often develops in people in their 60s and 70s, but it can also begin much earlier, including in the teen years or early adulthood.

“He said, ‘There’s nothing you can do for it. I suggest you sit down, have a glass of wine, and write a letter to relax yourself a bit,’” Melissa recalled.

Thanks to a chance meeting at a party two years ago, Melissa learned about a proven treatment option for symptoms of tremor: focused ultrasound. Furthermore, one of the nation’s most experienced centers in the procedure happened to be just over an hour’s drive from her home in Amherst, New Hampshire—the Mass General Brigham Neuroscience Institute.

Experience spanning 800+ patients

Melissa’s fellow partygoer, who worked for a medical devices company and was very familiar with focused ultrasound, recommended she contact the Neuroscience Institute. She set up an appointment with neurosurgeon John Rolston, MD, PhD. Over the past decade, Dr. Rolston and the team at Mass General Brigham have conducted focused ultrasound more than 800 times.

“When it comes to tremor, we’ve known for decades that a small spot deep in the brain is overactive—and that making this area less active helps ease symptoms,” he said. “With focused ultrasound, we use sound waves to heat that area just enough to create a tiny lesion, which quiets the faulty signal.”

When she first met Dr. Rolston, Melissa was eager to hear about focused ultrasound. Her left hand had become so shaky that she couldn’t hold a glass of water or paint with her beloved watercolors. She had trained herself to write and paint with her right hand, but now symptoms of tremor were emerging in her right hand along with her legs.

Given the severity of the tremor in her left hand, its impact on her quality of life, and the fact that the medications prescribed by her local neurologist hadn’t helped, Dr. Rolston thought Melissa would be a good candidate for focused ultrasound.

“It’s one of the best treatments we have right now to stop the tremor,” Dr. Rolston said. “Unlike deep brain stimulation, another option, focused ultrasound requires no anesthesia, incisions (cuts), or devices to be implanted. The outcomes are outstanding. Most people are far better off after the procedure than beforehand.”

Melissa agreed to proceed.

‘I was blown away’

When Melissa returned to Mass General Brigham, the first step was to have an MRI scan done so Dr. Rolston could see exactly where to target the treatment.

The next day at the hospital, Sherry Iuliano, NP, completely shaved Melissa’s head, as hair can compromise the accuracy of the sound waves. Then she and Dr. Rolston placed a halo (metal ring) around Melissa’s head to keep her still.

Once Melissa was positioned inside the MRI machine, the first treatment cycle began. Over the course of about 20 seconds, Dr. Rolston used the ultrasound machine to direct hundreds of tiny, highly focused sound waves to the targeted area of the brain. Two similar treatments followed, with short breaks in between.

Following the third treatment cycle, Melissa was able to sign her name and draw circles perfectly. The tremor in her left hand was finally gone. All told, the process took about two hours.

Minimal side effects

Patients undergoing focused ultrasound report minimal side effects. The most common one that Dr. Rolston sees—and one that Melissa had for a week or two—is a slight loss of balance. She has also experienced some fatigue.

Today, four months after the procedure, Melissa is thrilled with the results. She still writes and paints with her right hand but has begun using her newly steady left hand for more tasks. Recently, she had her first haircut since her head was shaved.

“Everybody says that’s the worst part of it, but it’s not so bad. The hair all grows back,” she says. “Besides, it’s such a small price to pay.”

Melissa looks forward to having focused ultrasound done on her right hand. The U.S. Food and Drug Administration requires a nine-month gap between treating opposite sides of the body to promote healing and enable doctors to confirm treatment effectiveness.

If a patient’s tremor comes back in a significant way, focused ultrasound can be repeated safely. In Dr. Rolston’s experience, though, this is a rare occurrence.

“We’re seeing really good long-term outcomes in our patients that we’ve been following and in data from other centers around the world,” he says. “This seems to be a very durable procedure.”

However, Dr. Rolston cautions that essential tremor is a progressive disease. Even if focused ultrasound reduces or eliminates symptoms, However, published five-year data and Mass General Brigham’s experience with patients followed for several years suggest the benefits can be durable for many years.

“We’re not curing the disease,” he says. “But if we can turn back the clock a decade or two for a patient, that’s a meaningful improvement in their quality of life.”

A message to others with tremor

Despite its excellent outcomes, many community neurologists are not familiar with focused ultrasound. Dr. Rolston said that many of his patients learn about the procedure—and find him—through their own research. He and his colleagues try to get the word out through webinars and other efforts. They also train neurosurgeons from outside of Mass General Brigham on the procedure.

Melissa urges other patients with tremor to consider focused ultrasound. And if they’re looking for an experienced neurosurgeon to perform the procedure, she doesn’t hesitate to recommend the Neuroscience Institute.

“My left hand is perfect now. Absolutely perfect,” she exclaimed. “I can’t say enough about Dr. Rolston. He is so nice, was willing to answer any questions I had, and took what I had to say seriously. And his entire team was supportive and nurturing. The whole time you’re there, you’re the most important person in their lives.”

Typically, ET is noticed first in a patient's 60s or 70s, though another group of patients can get it as teenagers or in their 20s. Melissa was a good candidate since she had tried and failed multiple medications, and her tremor was significantly impacting her life.